Closure Certificate by zre53877


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									                                                            CERTIFICATE OF CLOSURE
                                                           Emergency Closures Reporting
                                                                   2008 - 2009
Reporting Period
                      (1st period, 2nd period or 3rd period)

District #                                                     District Name

In compliance with I.C. 33-1003A, certify the cause and duration of each incident of emergency school closure.

 For each emergency closure, show the number of instructional hours missed for each grade grouping.
 If the missed instructional hours in each grade grouping for all buildings in the district where the same, then fill one line listing "All".
 If the emergency closure was for 2 or more consecutive full days, show on one line the date(s) of the closure.
 Report instructional hours to 2 decimal place.

 Attach a copy of the school board minutes showing approval for each emergency closure stating the cause and duration.

                                                                                 Amount of           Amount of           Amount of            Amount of
 Building Number
                               Cause for the                                    Kindergarten         Grades 1-3          Grades 4-6          Grades 7-12
         or if                                                     Date(s)
                             Emergency Closure                                  Instructional       Instructional       Instructional        Instructional
  District Wide All
                                                                               Hours Missed*       Hours Missed*       Hours Missed*        Hours Missed*

                                                                                        I certify that this information is accurate. If requested,
                                                                                    I will provide the detail to document the reported information.
Please submit with the Attendance and Enrollment Reports.
                                                                                                                                Superintendent's Signature
*Be sure to reduce your instructional hours on your school calendars to reflect the closure.

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